Is Cannabis Effective for Cluster Headache?

Neurology Reviews. 2010 August;18(8):13

The effect of marijuana in patients with cluster headache varies widely, according to researchers.

LOS ANGELES—For patients seeking relief from cluster headaches, cannabis may not be the answer, according to research presented at the 52nd Annual Meeting of the American Headache Society. About 53% of patients reported cannabis’ effect as “variable or uncertain,” and 22% rated the effect of marijuana on their headaches as “worse or unuseful.” However, 22% of subjects said that cannabis provided more than 50% benefit, and 3% reported that it was very efficient.

“The effect of cannabis on cluster headache attacks is not clear, as 75% of patients find it poorly efficient, but 25% still claim efficacy,” stated Elizabeth Leroux, MD, of the Emergency Headache Center, Hôpital Lariboisière, in Paris, and colleagues. “Cannabis use in cluster headache patients is frequent, especially in men, and has legal implications, lifestyle repercussions, and potential cerebrovascular risks.”

Dr. Leroux’ group analyzed questionnaires from 139 patients with cluster headache who had presented to the Emergency Headache Centre in Paris and at the Headache Clinic in Marseille, France, to document the frequency of cannabis use as well as its effect on headache attacks.

Among the 139 patients, 83% were male (mean age, 40; mean age of females, 43), 67% had episodic headache, and 30% had chronic headache. About 45% of participants were cannabis users—who were defined as those who engaged in any repeated use, excluding one isolated use as a teenager—and 74% had smoked tobacco. In addition, 32% of subjects had used cannabis within the past six months.

In comparing users with nonusers, the mean age of cannabis nonusers was 44.6, and the mean age of users was 36.2. About 92% of cannabis users had also used tobacco, compared with 59% of nonusers who had used tobacco. “Cannabis use in cluster headache patients seems to be higher than in the general French population—45% versus 12%, respectively,” reported Dr. Leroux and colleagues. “Users are more likely to be young men and to be tobacco smokers.”

Dr. Leroux’ group found that 27 patients had specifically tried cannabis in an attempt to treat their cluster headaches. Among the 63 cannabis users, 43% avoided use during a headache attack, 38% did not avoid use during an attack, and 19% did not provide a response. Furthermore, 27% of participants believed that cannabis could provoke an attack, 59% did not think that it could, and 19% did not respond. Four patients noted that cannabis could either provoke or abort a cluster headache attack.

“Substance use should be addressed when caring for cluster headache patients to prevent complications from use and potential interactions with prescription drugs,” stated the investigators. “The therapeutic potential of cannabis for cluster headaches is to be considered on a scientific basis, but mixed results observed by patients suggest that structured trials with synthetic, selective cannabinoids should be the way to investigate this topic further.”